OBJECTIVES

The objective of this study is to estimate the reduction of loss of life expectancy (LE) and cost-effectiveness of PCI in patients with acute myocardial infarction (AMI).

METHODS

After interlinkages of National Mortality Registry and reimbursement database of National Health Insurance (NHI) of Taiwan, we obtained 52,546 hospitalized new cases of AMI from 1999 to 2015. Among them, 31,978 patients received PCI, while 20,568 received conventional medical treatment. The survival functions were first estimated by Kaplan-Meier method and extrapolated by a semiparametric method. Namely, we simulated the survival function of age-, sex-, calendar year-matched referents for every AMI case based on national vital statistics, obtained the survival ratio, and performed logit transformation, which was used to construct a restricted cubic spline curve for extrapolation to lifetime through a rolling-over algorithm. The loss of LE was quantified by subtracting the LE of AMI cohort from that of the age- and sex-matched referents. We abstracted the monthly average medical costs from NHI, which were multiplied with the corresponding survival probability of patients with AMI in the two cohorts to estimate the lifetime healthcare expenditures.

RESULTS

The LE and loss-of-LE of patients treated with PCI were 16.6 (standard error of mean 0.4) and 4.1 (0.4) life-years, while those treated with conventional medical treatment were 11.5(0.2) and 6.2(0.2) life-years. The average lifetime medical expenditure per case of PCI and medical treatment were 60,361 USD and 52,482 USD, respectively, with 3% annual discount rate adjustment. The ICER (incremental cost-effectiveness ratio) of PCI would be 3,752 USD per life-year, lower than the GDP of Taiwan.

CONCLUSIONS

In general, PCI seems very cost-effective for patients with AMI. More studies are warranted to explore the ICER of AMI patients with different comorbidities.